Abstract
In order to determine the optimal amount of nutritional support for children (persons) with severe motor and intellectual disabilities (hereinafter referred as "children with SMID"), the amount of energy consumed at rest, resting energy expenditure(REE), was measured using the exhaled gas of persons admitted to this facility for children with SMID. For the group with high muscle tone, REE was significantly higher than the basal energy expenditure (BEE) calculated by Harris-Benedict formula, and for the group with low muscle tone, REE was significantly lower than BEE. There was no significant difference in the group with normal muscle tone. Regarding the amount of nutritional support for children with SMID, the appropriate method is thought to be to multiply REE by the activity index when REE is measured, or multiply BEE by the activity and stress index when REE is not measured, and adjust this amount by watching for body weight change each month. The activity index of children with severe disabilities was determined as 1.0 when bedridden according to Oshima's classification, 1.1 when the patient could sit on his/her own, and 1.2 when there are walking disability, and the stress index was determined as 0.9 with a tracheotomy, and 0.6 when on an artificial respirator all day. Multiplication of 1.0 or more was considered appropriate for persons who have high muscle tone, less than 1.0 for those with lower muscle tone, and 1.1 or more for those capable of oral intake. For children with SMID, the characteristics of the disability vary according to each case, but useful information regarding nutrition prescription could be obtained by indirect calorimetry which measured the actual consumed energy by the individual.
